Have changes in practice in response to COVID-19 been sustained? A qualitative study of experiences and perceptions of health system stakeholders in Colombia.

BACKGROUND: A wealth of qualitative research has been published on initial organizational responses to coronavirus disease 2019 (COVID-19). Research shows that a variety of changes in practice were introduced by health services internationally to address the challenges presented by the pandemic. These include the accelerated implementation of so-called service innovations, interventions to protect health system workers, admitting a role for trial-and-error approaches to decisionmaking, participation in international networks of information and expertise, combining so-called soft and hard coordination mechanisms and drawing on intersectoral collaborations to support the health system. However, less is known about the sustainability of responses.

METHODS: Focus groups and one-to-one interviews were conducted with 18 stakeholders within the Colombian health system from November 2021 to March 2022. Participants were derived from a broader set of 118 interviews to assess initial responses to COVID-19 in Colombia during 2020. Qualitative data collection was informed by a topic guide that examined the validity, acceptability and sustainability of six recommendations on the basis of initial changes in practice observed in response to the pandemic in 2020. Focus group data were analysed thematically by two researchers applying a coding framework.

RESULTS: The findings show that initial changes in practice, and identified gaps in the response, have varied regarding their sustainability. Gaps remain concerning the evaluation of accelerated innovations and formalizing learning from processes of trial-and-error experimentation. While coordination mechanisms within the health system, across sectors and over international networks have persisted, these often rely on informal coordination (e.g. self-nominated individuals) or precarious hard agreements among provider organizations that require institutional support to be sustained. Interventions to safeguard the healthcare workforce tend to rely on proactive behaviour by individual organizations; coordinated action at the local system and national levels is required to provide consistent support to the workforce.

CONCLUSIONS: Many of the challenges identified with Colombia's initial responses to COVID-19 in 2020 have persisted. Health research system investment is needed to support intimate working relationships between researchers and health provider and commissioning organizations to support the translation of informal, trial-and-error learning, often undertaken at the coalface of policy decisionmaking into validated, sustainable practices to which researchers can contribute ongoing evaluative methodological expertise.